{
"Npi": {
"NPI": "1437669926",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "REMINGTON RECOVERY CENTER, INC.",
"ParentOrgTIN": null,
"OrgName": "REMINGTON RECOVERY CENTER, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "215 REMINGTON BLVD STE G2",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BOLINGBROOK",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60440-3663",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "630-226-0162",
"MailingAddressFaxNumber": "630-226-0160",
"FirstLinePracticeLocationAddress": "215 REMINGTON BLVD STE G2",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BOLINGBROOK",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60440-3663",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "630-226-0162",
"PracticeLocationAddressFaxNumber": "630-226-0160",
"EnumerationDate": "10/10/2017",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "OSAFO",
"AuthorizedOfficialFirstName": "CYNTHIA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OFFICE MANAGER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "309-208-0270",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "324500000X",
"TaxonomyName": "Substance Abuse Rehabilitation Facility",
"LicenseNumber": "A-4169-0001-A",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}